Lola77

I work in a hospital on the acute rehab floor. We try to keep our patients out of bed as much as possible, but sometimes they cry and scream to get back into bed and sometimes the families yell at us to put them back. Of course, we also have family yell at us if they come in to find their mother/father/spouse in bed instead of sitting up. Obviously, if the patient is in pain or other distress, I put them to bed. But if they are just a bit tired or cranky or lazy or whatever (please don't yell at me for calling a patient lazy - if you work in rehab, you KNOW there are some patients who are truly lazy. I am not talking about the 95 yr old lady with a stroke. . .) What is good solid rational I can use with A&O patients and families for keeping patients sitting up and out of bed?

I need advice. Here is my story. New RN as of Fall 2009. Starting work on an insanely busy neuro/med surg floor that I really loved. I learned so much every day and was really starting to feel confident in my skills (IV starts, assessments, wound care, etc). After only 6 months, I had to move across the state and find a new job. I found a job on a neuro/tele floor, figuring that I could handle it. BOY WAS I WRONG. As a new nurse, my confidence was shaky, I was nervous about new people, policies, doctors, etc (this place was so different - even called labs different names - I was always confused). It was hectic and I had very little support. I began to dread work, get sick to my stomach. We were always short staffed, the other nurses were mean (except for 2) and the CNAs treated me like complete ****. I actually felt like my nursing license was in jeopardy at times. For example, I had no experience at all with cardiac drips, yet I was assigned patients that had them! It felt more like a step down unit, but with 6-7 patients per nurse. I was in over my head. Finally, after a month, desperate I went to my manager and said I didn't think I could handle the floor. She was very nice about it and said she would speak to HR about finding me another spot in the hospital (I had signed a 2 year contract and had to go somewhere). The only place they would put me was on acute rehab. I think they thought I was a sucky nurse who needed a slow environment (which isn't true! my old floor was known as THE CRAZIEST MOST HECTIC floor in that hospital and I thrived on the excitement!) Anyway, I didn't know what to do but needed the job so I took the rehab job. The people I work with are amazing - very nice, fun, helpful. The job is easy, it really is. Mostly med passes and helping patients to bathrooms. Some wound care, PEG tubes, trachs, but overall easy. I haven't learned a lot. Our patients rarely have IVs. I feel like I am losing my skills fast. The few times I have to start IVs I have blown the vein (I used to be pretty good!) and when I DO have a medical patient I feel like I don't remember things. You know - lose it if you don't use it. So now I fear that I will forever be trapped in rehab and will never be able to return to med/surg or anything more clinically complex. I have 18 more months on this floor. I have to stay on the floor with the contract. Also, nurses from my floor are not allowed to float anywhere but the pysch unit! So, my question is, how can I keep my skills sharp and make myself more marketable to a med-surg job when this contract is over? I have kept my ACLS card current and tell the other nurses on the floor to let me start all of their IVs and to let me know if they have complex wound care or any other medical issues so that I can help or do the procedure - but there really isn't a lot. Is there anything else I can do in your opinion? I am thinking of getting my BSN in the meantime - think that will help? I appreciate your feedback.

that is, without a doubt, the DUMBEST thing I have ever heard. Who goes to the ER to feel warm and fuzzy!?!? You go because you think you are freaking dying and need someone to save your life. Wow. Speechless.

Oh man, the mandatory nursery time. You guys have no idea what I have been through with it. I took my hypnobirthing class with a local doula/owner of a natural childbirth/yoga studio store and she is a local advocate for natural childbirth. She met with the director of the L&D dept and the physician liaison at the hospital I will be birthing at and I also contacted those people regarding this policy (I'm not the only one who is annoyed by it). Mandatory nursery time is MANDATORY - and these are their reasons: 1. the way they are set up, is that they have a central nursery with nursery nurses whose whole job is to do assessments and bathing. Those nurses cannot leave the nursery. 2. Staffing: the way they are staffed, my L&D nurse will not be my mother-baby nurse and is not my nursery nurse. According to them, no, assessments and bathing cannot be done by my MB or L&D nurse. Baby has to go to nursery. HAS to. They were completely inflexible. Overall, it is an older, inflexible environment. Hence my trepidation :) Luckily, I have a great midwife, doula and I am a nurse so I have an inkling of what is going on. Thanks for the pacifier comment - I will mention that. Will let you guys know how it goes! My goal is to be low key and nonconfrontational - I know it won't help anyone if I go in guns pulled and temper flaring. I know there is standing policy - hello, I'm a nurse! I roll my eyes at the stupid policies on my own floor all of the time! I just hope I find some kindred spirits on the L&D floor. I plan on bribing with chocolate :)

Oh, and due to insurance issues, I have to birth at this hospital - because I work at an affiliated hospital, it is pretty much free for me to birth here. Anywhere else, I would have to pay 50% of costs.

Hello, I posted on here earlier about my desire for a natural childbirth and the best way to approach the L&D nurses/be successful/not feel pressured into things. A lot of you responded and I really appreciate it. Like I said in my previous post, the hospital I will be birthing at has an excellent reputation for dealing with premature and sick babies (level III NICU, etc) but has a bad reputation for natural deliveries (unsupportive staff, 41% c-section rate, mandatory nursery time, etc) so I was hoping to be able to make it a good experience for everyone. I was wondering if you would read my birth plan and tell me if the L&D nurses will just laugh at me or be glad I made my preferences known? Any advice would be great. I know things may not work out the way I want, but I want to try to have my natural birthing experience and just hope to have a nice, supportive nurse :) Thank you! Birth Plan for ****** ******* Care Provider: **** ****** C.N.M. Doula: *** ******* Facility: ****** ******* ****** ******** My husband and I have chosen to use the Hypnobirthing method of birthing in order to experience a natural, pain medicine-free birth. We are very excited about giving birth at **** ***** and hope to have an amazing experience. If possible, we would like to request a nurse who is familiar with and supportive of natural childbirth. The following are our birthing preferences for during labor and after the birth of our son: During Labor: 1.To be supported in our choice to use Hypnobirthing techniques to naturally birth our baby by keeping the room quiet, the lights low, interruptions kept to a minimum, and speaking in a quiet voice. 2.To be supported in our choice to not have an epidural or pain medication. 3.To have my doula, **** ******, and my husband, ***** *******, at my side during labor. 4.To be free to walk around and change positions during labor. [note: they have wireless monitoring] 5.To be fully apprised and consulted before the introduction of any medical procedure including but not limited to: administering pitocin, cutting an episiotomy, breaking my water, etc. 6.When fully dilated, to be allowed to birth in a calm, quiet atmosphere free of prompts to “push”. Post-Partum: 1.To have immediate skin-to-skin contact with baby after deliver. 2.To exclusively breastfeed baby. 3.Delay application of Erythromycin to eyes for one hour to allow for eye contact with baby and bonding. 4.To delay cord clamping/cutting until after pulsation has stopped. 5.Mandatory nursery time to be as short as possible. Baby to remain in room with parents whenever possible. 6.No circumcision. *In the event that a special circumstance arises that causes us to deviate from our planned natural birth, we trust that you will provide us with a clear explanation of the special circumstance, the medical need for any procedure you many anticipate, and what options are available before proceeding. Thank you for reading this and helping us have a safe, memorable and satisfying natural birthing experience.

Hello! I am a med/surg nurse who is 34 weeks pregnant with my first child and will be delivering at a hospital close to my home (not the hospital that I work at - my hospital doesn't have an L&D). I have taken a Hypnobirthing class and am hoping for a natural childbirth. A CNM will be delivering my baby and I also have a Doula to help me. The hospital I am delivering at has a level III NICU and has a good reputation for difficult deliveries. It has a c-section rate of 41%. It also has a reputation for being less than cooperative with natural birthing mamas and for having older, "stuck in their ways" nurses who can be downright rude (for example, after a coworker of mine gave birth and was birthing the placenta, a nurse went to hook up Pit and my coworker asked to not have it. The nurse replied that "well, then I guess you will bleed to death" and stomped off) This is why I am posting. I am looking for advice to help me have the birth that I want while not alienating/******* off the nursing staff. I know things happen and am well aware that my birth plan may not go as planned. I also have elevated BP (not pre-eclampsia, it is a pre-existing condition) so I know that inducing me/other interventions may be a reality. I have talked at length with my midwife about that. But I really really really want to make an effort to have a natural childbirth and would love the support of the nursing staff in my quest. Any advice for how to make this happen besides just being nice and polite about it? Should I bring a basket of goodies for the nurses, or is that blatant bribing lol. I have a birth plan that I will bring - do nurses even read them? Do they help? I guess I just really want to know from L&D nurses what you need from me and what I can do as a patient to facilitate the process. I really appreciate the advice. I have been stressing about this a lot. Thank you.

I am an INFP and have found a happy home on an acute rehab floor. The pace is a bit slower, you get to know your patients, my coworkers (on my rehab floor anyway) are patient and kind, our doctors are awesome. Lots of education and teaching. Lots of wound care, diabetes teaching, straight cathing/bowel programs. Some trachs and ostomy. I think it is a good fit for this personality type.

depends on where you are moving from. If you are moving from anyplace where people are nice and civilized, then yes - get ready to deal with the most obnoxious, spoiled, demanding people you have EVER EVER met. I have worked in Boca area for a year now and am just starting to get used to the culture down here. If you are from New Jersey/NYC area, you will be fine. It will be just like home. Good luck.

I want to pursue an MPH and in an ideal world, would drive to school and take classes. However, the closest school to me that offers an MPH is an hour away in Miami and I will have a 6 month old baby and will be working full time as a nurse (3 12's) while going to school. FIU in Miami also offers a totally on-line MPH, but I worry that it will not hold the same weight as a degree earned on campus. What are your opinions? FIU is a large, state university so accreditation/being known is not a problem. I may also wish to pursue a doctorate, so this degree is important. I also worry that I will not be able to network and meet people if I do it all on-line. Thank you for your advice/opinions. I have been thinking about this a lot.

ooh where do you live? My husband is from Halifax, NS and I lived there with him for a year and LOVED it. What a beautiful province. Now we live in Florida Would love to return to Atlantic Canada someday.

Hello, I have been an RN for nearly 2 years, working in med surg and Acute rehab. I like rehab because of all of the education we do, but I don't want to work in a hospital forever. I am having a baby soon and in a few years would like to have a "normal" work schedule. I am interested in Public Health because of the education involved, because it is such a benefit to the community and because I like the atmosphere (I was volunteering there before getting pregnant - just doing clerical work) My background - BA in English and years of working as a technical writer. Then, AS in nursing and above experience. I was wondering if it makes more sense for me to get my BSN and pursue a nurse job in PH or get my MPH? Both are good options for me as they are both on-line through FIU here in South Florida. The BSN would be good because it gives direct clinical experience in public health, but is it necessary? With an MPH would I still be doing a job with contact with people? Because I want to do patient care/education. Thank you for input - just trying to figure out the different PH roles and how to get there :)

Looking at the master's in Holistic nursing offered at FAU in Florida. Looks amazing. However, after I get it will I just be an overqualified, overeducated, even MORE frustrated floor nurse with tons of awesome knowledge and zero time to practice it? In other words, what would this degree qualify me to do/where could I work? Anyone have a master's in holistic nursing?

so a couple of weeks ago, our hospital's DON decided to hold a hospital-wide CNA meeting - at 0730! Every single CNA in the hospital had to go. So, while we were changing shifts and giving report, there were no CNA's on the floor. I work on an acute rehab floor, so our patient need to be toileted and showered and have assistance to eat breakfast (which is served at 0730!) Anyone else think this is. . .incredibly stupid? Why not have two meetings - one in the morning and one around 1500? We actually had a patient fall occur at 0745 on our floor. Bed alarm was on, just no one responded quickly enough (patient fine - just trying to get to the bathroom like everyone else) Just. . .dumb. I feel like our DON is completely out of touch with floor nursing.

you feel that way because of the hierarchy in nursing - ICU nurses are "the best" and look down on the floor, med/surg nurses look down on LTC, etc etc. Acute care is supposed to be "real nursing" where as everyplace else is for people who can't find a job in acute care. At the end of the day who the hell cares? Work where you like, find a job you love whether it be in the ICU of a large teaching hospital or a tiny nursing home. It's YOUR job and your life. We are programmed as nurses in school to want to do acute care. If it floats your boat, do it. If not, go elsewhere. I have worked both acute care and acute rehab. . .and I like both for completely different reasons. But the rehab nursing is looked down on. However, be careful because like the other posters said, not all LTC is the same. Your old place sounds great. . but you may find an LTC that is short-staffed, full of snotty people and poorly managed and then you would hate it. So, look carefully. But don't be afraid to be honest with yourself about what you want :)

I didn't have a problem, but I knew the manager on the floor. Now, if I am a rehab nurse for 5 yrs I don't know if I could get a M/S job. But I don't think I will ever want one again. I did my time, learned a LOT, and now want to work acute rehab where I get to know my patients and do lots and lots of education. Good luck in your job!

Med-surg is different from ICU. My guess is if you worked a shift on the med-surg floor you may have a different opinion of those "stupid" MS nurses. They work their asses off with 5-6 acute patients. They don't have the autonomy ICU nurses. They called the RR and they were monitoring the patient. They did what they were supposed to do. Different environment, different skills set. Try a day on the floor - my guess is you will feel pretty "stupid" yourself.

PRN laxative. .what an emergency! If the lady would relax she could probably poop on her own. As for forgetting it, I would forget everything if it wasn't for my handy-dandy time management sheet. The one I used when I was on med-surg had a column for each patient with rows for each hour of the day. I would write down things I needed to do in the time slots (like check BS, labs, meds, IV meds, TX, whatever) and then cross them off when I was done. I would also add new stuff as the day went along. Every once in a while I would check it to see what still needed to be done. It was a life saver.I would also jot little notes like "called Dr. Bighead" or "called pharm" so that later if someone said I didn't call them, I could tell them exactly WHEN I called them. And as for looking young, I am 32 and look about 12 so I deal with that all of the time. When I was a new nurse and people would ask me how long I had been a nurse, I would reply "I have been in healthcare for 2 years" - it wasn't a lie - I had been a tech for 2 years! lol Good luck and hang in there and don't let the doctors bother you - just remember they are stressed and unhappy and nurses are the easiest people for them to take their frustrations out on. No, it's not right, but stand your ground, never be outwardly rude back, but don't take their ****.

ahhh so they can audit you! I had no idea. Ok, good to know. thank you! No one seemed to be able to give me a straight answer (like so many things har har har)

Um dumb question maybe. . .but what happens to my CEU's? Does the state track them? Like, when I got my ACLS/BLS they asked for my license # and I earned some CEU's. Do they get tracked anywhere? How do I track them/prove I have done them? I am so confused by this. I have to renew my license April 2011 and I have no record of all the CEU's I have done in various places.

thanks. The FIM thing is interesting. We do the whole freaking thing (including scoring) every shift, every day. What you do makes more sense. We are talking about maybe doing that in the future because doing 6 complete FIMS is a lot of time wasted in my opinion (plus I hate them lol) Our ratios are about the same. We try to keep it to 4-5 patients but 6 seems to happen most days. I love having 4-5 - gives me more time to chart and to help the CNAs with toileting and transfers and stuff. Not charting I&Os seems so weird to me. . .I find myself doing it anyway out of habit.

Brownie - what floor will you be working on? There is good and bad at Delray. I got hired into HORRIBLE but I transfered to a floor where i am very happy. yes, Delray is a for profit and that is obvious everywhere but there are good places within the hospital.

Just a poll: what are the patient:nurse ratios (for day and night) on your acute rehab floor in a hospital setting? what is the ratio for patient:CNA? Do you have a free charge nurse? what does he/she do? How often do your patients get showered? Do you track I&O's on all patients? Is your charting computerized? Do all nurses complete the entire FIM on each shift? On a scale from 1-10, how busy/stressed do you feel on a daily basis? How do the CNAs/Nurses get along on your floor? Just curious. I am working on my 2nd acute rehab floor and it has gotten me thinking about all the differences and what the "standards" are :)

dear god, if they floated me to peds to work with INFANTS I would be worried about my license. I have held a baby twice. I have no idea what is normal and what is not. I have no idea how to start an IV in a baby or how to assess. How do I give meds? HOW DO I EVEN FEED THEM??? If they could have guaranteed only older children (like, over 13) maybe I would have done it. But floated outside of your expertise is dangerous and wrong. hmmm. . .why don't you go to dialysis tomorrow? or cath lab? I mean, we are all nurses, right? what's the difference?? lol

just worked my first 3 days on the new rehab floor - and I am so happy. Yesterday was a complete crap day - two nurses called out, short staffed, a patient fall, a discharge and an admit, crazy patients, blah blah blah. . .and I watched as the nurses on the floor totally pulled together to get it all done. No negativity, no yelling or pettiness - just a bunch of tired nurses working to get stuff done. Even the nursing director was in a room at one point helping to clean up a patient!!!!!! So. . .I am happy. Nursing is a tough gig but when you find a good environment it can be a great gig.